JOURNAL OF ENDODONTICS

Copyright 2003 by The American Association of Endodontists

Printed in U.S.A.
VOL. 29, NO. 7, JULY 2003

Modified Usage of the Masserann Kit for Removing

Intracanal Broken Instruments
Takashi Okiji, DDS, PhD

ments that had been resistant to other techniques such as

bypassing.

The Masserann kit is a hollow tube device specially

designed for the removal of intracanal metallic objects. This report describes some modifications in
the usage of this device for effective removal of
tightly bound intracanal broken instruments whose
diameter is relatively large at the coronal end. The
techniques described are: (1) modification of the
extractor to ensure gripping by creating a wider
space inside the tube; and (2) combined use of the
modified extractor with an ultrasonic device and a
surgical operating microscope. A clinical case
demonstrating that these modifications resulted in
successful retrieval of firmly wedged instruments
is presented.

MATERIALS AND METHODS

The techniques proposed are: (1) modification of the Masserann
extractor to create a wider space inside the tube; and (2) combined
use of the modified extractor with an ultrasonic device (Enac III,
Osada Electronic, Tokyo, Japan) and a surgical operating microscope (OPMI 99, Karl Zeiss, Germany).
The modification of the extractor was carried out to create a
wider space between the tube and plunger. It was simply performed
by grinding the small extractor with a carborundum point and
consisted of cutting off approximately 0.5 mm from the tip of the
tube and sharpening the tip of the plunger (Fig. 1). The ultrasonic
device was used to cut the dentin around intracanal metallic fragments under the microscope and loosen the fragment by transmit-

Intracanal broken instruments impede thorough cleaning and shaping of the root canal system and thus may compromise the outcome
of endodontic treatment. However, orthograde removal of separated instruments is usually a significant challenge to practitioners.
There is no standardized procedure, and a number of different
removal techniques and devices have been reported (1).
The Masserann kit (Micromega, Besancon, France) is specially
designed for the removal of metallic objects from root canals (2).
It consists of a series of trepan burs that are used to prepare a space
around the most coronal part of an obstructing object and two sizes
(1.2 and 1.5 mm in outer diameter) of tubular extractors, which are
inserted into the created space and mechanically grip the object.
The extractor consists of a tube in which a plunger can be screwed
down. By tightening the screw, the free part of the object is locked
between the plunger and the internal embossment just short of the
apical end of the tube. There are several reports in which the
effectiveness of the Masserann kit has been presented (2 4). However, limitations exist regarding the application of this technique.
The trepan burs and extractors are rigid and relatively large, and
thus establishment of straight-line access to the target object often
requires considerable removal of the root dentin, potentially leading to failures such as root perforation (5).
The purpose of this article is to describe some modifications of
the Masserann technique for removing tightly bound intracanal
broken instruments whose diameter is relatively large at the coronal end. The modifications were effective in the removal of frag

FIG 1. Modification of the Masserann extractor. Before modification

(A), the space between the tube and plunger (P) is not sufficient to
grip a broken file of relatively large cross-sectional diameter (BF). (B)
Modified extractor in which the tip of the tube is cut off (arrow) and
the tip of the plunger sharpened (double arrow). With this modification, the broken file is gripped without any additional dentin cutting.

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Usage of Masserann Kit

467

ting ultrasonic energy indirectly through the grasping extractor or

directly under the microscope.

CASE REPORT
This case was treated at the Clinic for Conservative Dentistry,
Tokyo Medical and Dental University Dental Hospital. A 41-yrold male patient was referred for removal of a broken #30 K-file
in the mesiobuccal canal of his mandibular left second molar. The
referring dentist had pulpectomized the tooth 6 months earlier and
root-filled the canals, except for the mesiobuccal canal in which the
file had been separated accidentally. The tooth was sensitive to
percussion and palpation. The preoperative radiogram revealed
that the broken file extended from approximately 1 mm below the
orifice to the radiographic apex (Fig. 2A).
Because an attempt to bypass the broken file with K-files failed,
a decision was made to remove the file with the Masserann kit with
the aid of the surgical operating microscope. Under rubber dam
isolation, a guide groove, approximately 2-mm deep and circumferential to the coronal end of the broken file (Fig. 2B), was
prepared with the smallest trepan bur (1.1 mm in outer diameter).
Then the dentin between the file and the groove was removed
under the microscope with an ultrasonic spreader tip (ST21,
Osada), activated with the ultrasonic unit at the power setting of 5.
With this procedure, the periphery of the file was successfully
exposed (Fig. 2C) and was gripped with the modified extractor.
However, the file was tightly wedged into the dentin and efforts to
loosen it with manual pressure were unsuccessful. The ultrasonic
tip was applied directly against the exposed end of the file and
activated under the microscope. Alternate application of the ultrasonic vibration and counterclockwise rotation with the extractor
finally resulted in the successful withdrawal of the file (Fig. 2D).
The total time to retrieval was approximately 30 min.

FIG 2. (A) Preoperative radiograph showing a broken #30 K-file

(arrows). (B and C) Views under the operating microscope, showing
guide groove prepared with a trepan bur (B) and exposed end of the
file (arrowhead) after ultrasonic cutting (C). (D) Removed file gripped
by the modified extractor.

Solid dentin often remains around intracanal broken instruments

even after repeated cutting with trepan burs. The remaining dentin
hampers gripping with the extractor and is thus a major reason for
failures of the Masserann technique. The present case clearly
demonstrated that the difficult task of exposing the periphery of the
fragment could be readily performed with the aid of the surgical
operating microscope; just enough dentin was successfully removed with the guide groove preparation and subsequent ultrasonic cutting under the magnified view.

DISCUSSION

CONCLUSION

The Masserann kit has been used for over 30 yr as a device for
removing intracanal broken instruments. The locking mechanism
of the extractor provides considerable retention, which is a major
advantage of this device. As recognized widely, however, it is in
the removal of the dentin around the object where difficulty lies
(5). Moreover, practitioners may encounter the frustrating situation
in which a wedged object does not come out despite successful
gripping of its coronal end. The modifications of the Masserann
technique presented here ensured firm gripping and loosening of
tightly wedge obstructions and may be helpful in solving some
cases with the above-mentioned difficulties.
In the present case, the diameter of the coronal end of the broken
instrument was approximately 0.6 mm. Because the caliber of the
small tube is approximately 0.7 mm at the embossment, the space
inside the small extractor was too narrow to firmly grip the instrument. Application of the large extractor to the mesial root of the
mandibular second molar may be contraindicated because it requires too hazardous trepanation. However, the modification of the
extractor resulted in increased retention without further removal of
root dentin or reducing the diameter of the exposed end of the
fragment with circumferential grinding. Clinical experience suggests that the modified extractor is effective where the diameter of
the coronal end of obstructions is approximately 0.45 to 0.6 mm.

The procedures presented indicate that the classic Masserann

technique may still be effective in selected cases, particularly those
where tightly wedged broken instruments exist in a readily accessible position. Combined use of the Masserann technique with
microscopes and ultrasonic instruments may solve some extremely
difficult cases.
Dr. Okiji is professor, General Dentistry and Clinical Education Unit, Niigata
University Dental Hospital, Niigata, Japan. Address requests for reprints to
Takashi Okiji, General Dentistry and Clinical Education Unit, Niigata University
Dental Hospital, 2-5274, Gakko-Cho, Niigata 951-8514, Japan.

References
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endodontic instruments. J Am Dent Assoc 1974;88:588 91.
4. Krell KV, Fuller MW, Scott GL. The conservative retrieval of silver cones
in difficult cases. J Endodon 1984;10:269 73.
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